Individual
CHANTAL BRAZEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
90 BERGEN ST, LOWER LEVEL SUITE 300, NEWARK, NJ 07103-2425
(973) 972-2111
(973) 972-2754
Mailing address
30 BERGEN ST, ADMC 12 1205, NEWARK, NJ 07107-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA04667000
NJ
2084P0800X
Psychiatry Physician
25MA04667000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1582305
—
NJ
Enumeration date
08/31/2006
Last updated
02/02/2022
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